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The laparoscopic adjustable gastric band, or the Lap-Band, is a restrictive
operation wherein a silicone band is wrapped around the upper part of the
stomach to create a small stomach pouch. The
lower, larger part of the stomach remains below the band. These two parts
remain connected by a small outlet created by the band. The passage of food into the lower stomach
is slowed by the restriction. The result is that you feel
full with only a small amount of food and you feel full longer.
The narrowing created by the band can be adjusted.
How? The band is connected by tubing to a reservoir of saline solution which is placed
well under your skin and fat during surgery. This reservoir cannot be
seen, but can be felt when you push on your abdomen. After the operation, the
surgeon can control the amount of saline in the band by entering the reservoir
with a fine needle through the skin. The inner surface of the band is thus inflated or deflated,
just like a blood pressure cuff.
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Advantages:
- Laparoscopic gastric
banding is presently the most commonly performed weight-loss operation
outside of the United States (in Australia and Europe) and was recently
approved by the FDA.
- Weight-loss ranges
from 50% to 65% of excess body weight over the first 2 years and is
maintained up to 5 years. This equals roughly 50-100
pounds, depending on your original weight. Although observed weight-loss
was lower in the FDA clinical trials, resulting in only 35% excess weight-loss,
there were significant differences in surgical and clinical technique.
- It is the least
invasive surgery of all the weight-loss surgeries available. Since there
is no cutting or re-connecting of the stomach or intestines, there is no
risk of intestinal leak, dumping, or food intolerance.
- Patients who have
the Lap-Band in place do not feel hungry. This appears to be due to the
stretching of the uppermost part of the stomach.
- There is no malabsorption
of medication or protein. This is particularly important in young women
who want to get pregnant. Although, you do not need any vitamin or mineral
supplements, we recommend a multivitamin once a day.
- The majority of existing co-morbidities
are improved, or even cured.
- Since the band is an implantable device, it is 100% reversible just by taking it out.
- The surgery takes approximately 1 hour to perform and requires only an overnight stay in the hospital.
You can be back at work in 3-5 days.
- It is adjustable.
This does not require more surgery, but instead, a 10 minute visit to
your surgeon's office. As you lose weight, you will need the band
tightened, therefore you must be committed to see your surgeon frequently
during the first 1-3 years. In certain circumstances, you will need
to eat more (ie. pregnancy, illness), in which case the band can be loosened.
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Disadvantages:
- You must re-learn
how to eat. Think of it as a 6-lane highway of cars narrowing down to
1-lane because of construction. It takes you longer to get past the
construction site, but once you are past it, it is back to 6 lanes and
smooth sailing to where you want to go. So the more cars there are,
or the more food you take in, the greater the back-up is before you
reach the narrowing. Therefore, if you eat too fast, too much, or don't
chew your food enough, you will vomit. Some foods will not pass through -
such as steak, white meat chicken, and doughy bread.
- Success of weight-loss with the Lap-Band is 70% dependent on your commitment to follow-up
with your surgeon every 6-8 weeks for at least the first year. Your
weight-loss, eating habits, and various symptoms will determine
whether you need an adjustment of your band. This is the only way to
assure significant long-term weight-loss. If you do not follow-up with
your surgeon, you will not lose weight.
- Because the Lap-Band
is an implantable device, it does carry the risk of slippage (causing
complete blockage of the gastric pouch) or erosion into the stomach
(causing weight-loss to stop). In either of these cases, another laparoscopic
surgery would be required to either re-position the band if it has slipped,
or remove the band if it has eroded. This occurs rarely, but is a possibility.
- The Lap-Band is
not a perfect solution and will not result in weight-loss if you start
eating an excess of chocolate or high-calorie drinks (such as ice cream
shakes and soda).
- Although rare in occurance, the saline reservoir tube may kink or leak, or the reservoir may twist.
A minor operation to correct the problem may be required.
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